Development and Validation of the Body Concealment Scale for Scleroderma

Area of Science:

• Psychology
• Dermatology
• Rheumatology

Background:

• Body concealment is a common social avoidance behavior in individuals with visible differences.
• Systemic sclerosis (SSc) can cause disfiguring physical changes, leading to significant body concealment.
• Existing measures may not fully capture the nuances of body concealment specific to SSc.

Purpose of the Study:

• To develop and validate a reliable and valid scale measuring body concealment in patients with systemic sclerosis.
• To assess the psychometric properties of the Body Concealment Scale for Scleroderma (BCSS).

Main Methods:

• Item analysis was performed on an initial sample of 93 American SSc patients to select scale items.
• Confirmatory factor analysis (CFA) using single-factor, two-factor, and bifactor models was conducted on 742 Canadian SSc patients.
• Convergent and divergent validity were examined by correlating the BCSS with the Brief-Satisfaction with Appearance Scale (Brief-SWAP), depressive symptoms, and pain measures.

Main Results:

• A 9-item, two-factor model (Clothing Concealment, Hand Concealment) demonstrated a good fit, with factors being highly correlated.
• A bifactor model also showed a good fit, indicating a strong general body concealment factor.
• The BCSS total score showed stronger correlations with appearance-related measures (Brief-SWAP subscales) than with depression or pain, supporting its validity.

Conclusions:

• The Body Concealment Scale for Scleroderma (BCSS) is a valid and reliable measure for assessing body concealment in SSc patients.
• The BCSS extends the understanding of body concealment and avoidance beyond body weight and shape concerns.
• This scale can aid clinicians in addressing the psychosocial impact of visible differences in SSc.